Portal vein thrombosis (PVT) is a prothrombotic state caused by blood flow stasis, vascular injury, and/or hypercoagulability, resulting in partial or complete occlusion of the portal vein. PVT is a rare diagnosis, particularly among those without liver disease. Typical risk factors for PVT include cirrhosis, hepatocellular carcinoma, myeloproliferative neoplasms, other malignancies, oral contraceptive use, bowel infections, and inherited hypercoagulable disorders. The goal of this study is to analyze a case of PVT in a patient in which no clear etiology could be identified and to evaluate whether the patient's methylenetetrahydrofolate reductase (MTHFR) polymorphism may have been a risk factor. This is a case of a 44-year-old female with a history of irritable bowel syndrome, hypertension, hyperlipidemia, sleep apnea, gastric bypass surgery, and MTHFR polymorphism who presented to a walk-in clinic with five days of severe abdominal pain associated with diarrhea, nausea, and anorexia. Hypertension and tenderness over the right lower quadrant prompted a referral to the emergency department for evaluation of possible appendicitis. A contrasted computerized tomography (CT) scan of the abdomen and pelvis revealed a normal appendix and acute portal vein thrombosis. She was then admitted for treatment with intravenous (IV) heparin, fluids, and pain management. After an uneventful three-day hospital course, the patient was discharged on rivaroxaban with a plan to continue anticoagulation therapy for six months and follow up with a hematologist, who later confirmed the patient did not have any inherited hypercoagulable disorders.It is unclear whether the patient's MTHFR polymorphism prompted her PVT as existing data on MTHFR's effects are limited and conflicting. One cannot conclude that MTHFR caused a state of hyperhomocysteinemia to prompt hypercoagulability, as this has not been consistently proven in current literature, and the patient's homocysteine levels were not measured at the time of diagnosis. This case illustrates that further research on the various MTHFR polymorphisms and their effects on coagulation, potentially via homocysteinemia, is warranted. Further research on the MTHFR polymorphisms may help determine whether providers should test for MTHFR in the evaluation of thrombotic risk factors and may help optimize the treatment of thrombotic events for affected individuals.
INTRODUCCIÓN: Se han descrito múltiples técnicas quirúrgicas para el tratamiento de las hernias incisionales buscando reducir las complicaciones postoperatorias y la tasa de recurrencia, siendo la de Rives-Stoppa una de las más empleadas actualmente. Se presentan los resultados obtenidos con esta técnica para el tratamiento de las eventraciones de línea media.MÉTODOS: Se intervinieron 10 pacientes con hernias incisionales (Abril 2009-Octubre 2016), recopilando datos epidemiológicos, características de las hernias y técnica quirúrgica. Se evaluó el grado de satisfacción y el dolor postoperatorio mediante una escala visual analógica (EVA), siendo controlados al mes y al año postquirúrgico.RESULTADOS. Se incluyeron 58 mujeres y 42 hombres con una edad media de 62,32±12,6 años. 38 pacientes presentaban eventroplastias previas. Las localizaciones y tamaños más frecuentes, según la European Hernia Society (EHS) fueron M3 (23%) y M4 (21%), y W2 (49%) y W3 (40%). Se empleó malla de polipropileno de baja densidad en el 93%, con overlap de 5 cm (RIQ: 4-6). La estancia hospitalaria fue de 2 días (RIQ: 2-4), morbilidad del 20% y mortalidad del 4%. La puntuación álgica el primer día postoperatorio fue 5 (RIQ: 2-7), reduciéndose a 0 (RIQ: 0-2) al mes. La tasa de infección de herida fue de un 8% y de recidiva al año del 13,2%. El 91% resultaron satisfechos tras la cirugía.CONCLUSIONES: En los pacientes intervenidos de hernia incisional de línea media mediante la técnica de Rives-Stoppa se obtienen buenos resultados de dolor, grado de satisfacción, tasa de recurrencia y complicaciones de herida.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.